This document discusses hospital acquired infections (HAIs), also known as nosocomial infections. Some key points: - HAIs affect around 2 million people in the US each year, resulting in about 90,000 deaths. - Common types of HAIs include urinary tract infections, respiratory infections, and surgical site infections. - HAIs increase mortality, morbidity, and hospital length of stay. - The chain of infection involves an infectious agent, reservoir, mode of transmission, portal of entry/exit, and susceptible host. Breaking any link can prevent infection. - Strict hand hygiene, isolation precautions, and antibiotic stewardship are essential to control and prevent HAIs.

2. “Hospital acquired infections represent a serious and
growing health problem”
 CDC – 2 million people acquire HAI every year
 Mortality is about 90,000 as a result of infection
 The Infection Control Committee was initiated on 1969
 The study of efficacy of the Nosocomial infection was
initiated on 1985

3.  Any infection that is not present or incubating at the
time of admission to the hospital
 That is acquired more than 48 – 72 hrs after admission
and within 10 days after hospital discharge
HAI:
 Lengthens hospital stay
 Increases both mortality and morbidity
 Total prevention is difficult and so control is
essential

4.  Most common
Urinary Tract Infection (UTI) 20 – 25%
Due to indwelling urinary catheters
 Respiratory tract infection 2nd
common
15 -20% related to respiratory devices
 Surgical site infections 12%
Can occur incision and deep tissues of a wound
 Blood stream infections-6%
Related to intravascular devices

5. Portal of
entry
into
host Mode of
transmission
Reservoir
Portalof
exit
from
reservoir
Susceptible
host
Causative agent
“Removing any one link breaks the chain
and prevents infection”

6.  Causative agent:
Any microbe
Exogenous/endogenous
 Reservoir:
Inanimate objects
Human beings
Animals

7.  Portal of exit:
Respiratory
Genitourinary/ gastrointestinal
Skin/mucous membrane/placenta(mother to fetus)
 Mode of transmission:
Easiest link to break
a) Contact transmission-Direct/indirect :
Hand washing is the most effective way to prevent
transmission by contact route

8. b) Droplet transmission:
Cough / sneeze
Influenza /whooping cough
c) Air borne transmission:
PTB / Varicella / Measles
 Portal of entry:
Usually same as portal of exit

9.  Age factor
 Poor health status
 Immuno compromised
 Invasive diagnostic tests
 Use of broad spectrum antibiotics

10.  Elimination of infectious agent
- Isolation of the patient
- Barrier precautions
- Effective disinfection and sterilization of equipments
- Cleaning of environment

11.  All patients are potentially infectious
 Wear gloves – blood, body fluid and contaminated
items
 Wash hands frequently with soap or hand rub
 Patient care equipments – Disposable – Discard
- Reusable – decontaminate
 Proper sharps disposal
 Spills – clean with bleach or 1:10 Sodium hypochlorite
solution

12.  MRSA, Pseudomonas, ESBL producers, Salmonella/
Shigella
 GI tract infections/skin infections
 Patient to be isolated in private rooms
 Wear gloves when entering the room
 Wear mask and goggles – blood and body fluids

13.  Isolate in private room or spatial separation of 3 feet
 PPE is essential
 When transporting, surgical mask to be provided to
patients
 Pneumonia, Pertussis, Influenzae, virus, RSV

14.  Private room with negative air pressure
 Person entering the isolation room should wear
respirator mask
 PTB / Measles / Varicella

15.  Instruments used in diagnostic/therapeutic procedures
need
- Thorough mechanical cleaning
- Proper sterilization
- Rinsing with sterile water
- Proper drying
 Disinfection
- Use of disinfectants
- Follow manufacturers instructions (MSDS)expiry date to
be
checked
- Do not refill containers
- Do not use empty containers for storing other solutions

16. Antibiotic Policy:
 Undue usage of antibiotics
 Emergence of MDR strains
 Strict “Antibiotic Policy” is essential
 Undue usage - Emergence of MDR strains
 Antibiotic policy is a must
Restrictive Rotational

17. Hospital Personnel:
 Hospital staff- potential sources of infection
 Monitoring – kitchen staff
 Units with high risk patients – bacteriological
monitoring
Employee Health Care:
 Hospital employees in high-risk areas, Staff and Doctors
to be given Hep ‘B’ vaccination – 3 doses
 Education program in Infection Control policies &
practices

18. Occupational Exposure Form
 To be strictly maintained
 Sharp injury – needs thorough washing
 Assessment of patient status – HBsAg, HCV & HIV
 HCW status assessment & necessary action
 Counselling

19.  Supporting development of an effective infection
control programme
 Develop policies and procedures
 Occupational health and safety
 Education & Training

20. Infection Control
Committee
Hosp. Epidemiologist
Inf. Con. Practitioner.
Clinical Microbiologist
Epidemiology Nurse
(Infection Control
Nurse)
Policies &
Regulations
Members from other
departments
Medical Director &
Administrative Head
Regular Monitoring
Continuing
Education
Surveillance

21.  Plays an essential role
 Good working relationship with clinicians
 Report antibiograms of organisms
 Monitoring MDR ,MRSA, VRE organisms
 Identify pseudo & true out breaks
 Perform surveillance cultures

22.  Foundation for organizing &maintaining an effective
infection control programme
 Useful for Infection Control Team and Infection
control committee in identifying areas of priority &
allocating resources accordingly

23. Main objectives of surveillance
 Reducing infection rates within healthcare facilities
 Establishing endemic infections rates
 Identifying outbreaks
 Convincing medical personnel to adopt recommended
preventive practices
 Comparing infection rates between health care
establishments
 Evaluating infection control measures

24. 1. Continuous surveillance
 Entire health care facility
 Time consuming & not cost effective
2. Targetted surveillance
 High risk areas
 More effective and manageable

25.  Name, age & sex
 Date of birth
 Hospital record number
 Ward or unit in the hospital
 Name of the consultant
 Unit involved
 Date of admission
 Date of discharge or death
 Site of infection
 Organism isolated with antibiotic sensitivity

26. “Occurrence of disease at a rate greater than that
expected within a
specific geographical area & over a defined period of
time”
Management:
 Communicate to relevant staff
 Laboratory support for effective investigations
 AST and molecular typing is essential
 Stocking outbreak isolates
 Take immediate control measures
 Monitor the effectiveness of control measures

27.  Screen personnel and environment
 Write a coherent report
 Summarize investigations & Recommendations to
appropriate authorities
 Implement long term infection control measures for
prevention of similar outbreaks

28. Decontaminationof
environment
Decontaminationof
items&equipment
Handwashing
Isolationofpatients&
barrierprecautions
Prudentuseof
antibiotics
5 pillars of Infection Control

29.  SSI are considered to be nosocomial if the infection
occurs within 30 days of operative procedure or within
a year if a device or foreign material is implanted
Third common HAI

30. Host related Procedure related
Age
Obesity
Disease severity
Nasal carriage of Staph.aureus
Duration of pre-operative
hospitalization
Mal nutrition
Diabetes mellitus
Malignancy
Immuno suppressive therapy
Pre-operative hair removal
Type of procedure
Antibiotic prophylaxis
Duration of surgery
Multiple procedures
Tissue trauma
Foreign material
Blood transfusion
Pre-operative showers
Emergency surgery
Drains

31.  Staph.aureus
 Coagulase Negative Staphylococci
 Enterococcus sp
 E.coli
 Pseudomons sp
 Enterobacter sp
 Proteus mirabilis
 Klebsiella pneumoniae
 Other Streptococcus sp
 Candida albicans

32. Class 1 - Clean wound
Class 2 - Clean contaminated wounds
Class 3 - Contaminated wounds
Class 4 - Dirty wounds

33. Class 1 - Clean Wound:
 When operative procedures does not enter in to hollow
viscus or lumen of the body
 SSI rates - < 2%
 Originates from the contaminants in the operating room
environment
 From surgical team or most commonly skin

34. Class 2 - Clean Contaminated Wound:
 When the operative procedure enters into colonized
viscus or cavity of the body but under elective or
controlled circumstances
 SSI rate – 4-10%
Class 3 - Contaminated Wound:
 When gross contamination is present but no infection is
obvious a surgical site is said to be contaminated
 SSI rate – can exceed 20%
 Contaminants are bacteria that are introduced by soilage
of surgical field

35. Class 4 - Dirty Wounds:
 If an infection is already present in the surgical site it is
considered to be dirty
 Pathogens of active infection as well as unusual
pathogens are likely be encountered
 SSI rates - > 40%

36. 1. Superficial incisional
2. Deep incisional
3. Organ / space SSI

37. Infection occurs within 30 days from surgery and
involves only skin or subcutaneous tissue and atleast
one of the following:
1. Purulent discharge, with or without lab confirmation,
from the superficial incision
2. Organisms isolated from an aseptically obtained
culture of fluid or tissue from the superficial incision
3. At least one of the signs or symptoms of infection
4. Diagnosis of SSI by the surgeon
5. Infection that extends into fascial and muscle layers
should not be taken as superficial incisional SSI

38.  Infection occurs within 30 days after the operation if
no implant is left in the place or within 1 year if
implant is in place
 Infection involves deep soft tissues
Involves one of the following:
 Purulent discharge from deep incision
 Spontaneously dehisces or delibrately opened by
surgeon when the patients has signs and symptoms
 An abscess or other evidence of infection involving
deep incision or during re-operation

39.  Infection occurs within 30 days after the operation if no
implant is left in the place or within 1 year if implant is in
place
 Infection involves any part of the anatomy other than
incision which was opened or manipulated during an
operation
Involves the following:
 Purulent drainage from the drain i.e., placed through a stab
wound in to organ/space
 Organism isolated from aseptically obtained culture of
fluid or tissue
 An abscess or other evidence of infection involving deep
incision or during re-operation

40.  Pre operative showers
- decreases infection rates in patients when showered
with antiseptic solution
 Pre operative hospitalization
- should be kept to minimum before surgery
- longer the stay increase in SSI rates
 Pre-operative shaving
- should be avoided (Skin bruises and trauma)
- Increase the risk of SSI
- Depilatory cream – decreased SSI
- but causes skin irritation and rashes

41.  Improvement in timing of initial administration
 Appropriate choice of antibiotic
 Short duration of administration
 Prophylactic antibiotic is indicated in class 1,2,3
 Therapeutic antibiotic is indicated in class 4

42.  Principle of surgical asepsis must be followed
 Appropriate skin disinfectants should be used
 Clothing contaminated with blood of body fluids
should be removed as soon as possible and bagged
 Wear fluid repellent high efficiency mask during
procedures
 Gloves, mask, goggles, face shields, closed foot wear

43.  Antiseptic skin preparation
- applied with friction in concentric circles
- moving away from proposed incisional site to periphery
well beyond operating site
 Sterile drapes used in OT should be impervious
 Staff movement should be minimal

44.  Wound dressing
- Appropriate training for the staff is essential
- minimal frequency of dressing
- Dressings should not be opened for 48 hours after surgery
unless
infection is suspected
 Theatre acquired infection
- Deep seated
- Occurs within 3 days of surgery or before first dressing
- Many infections may not be recognized for weeks or months
particularly after prosthetic surgery

45. Post operative stay:
 Avoid prolonged post operative stay
 Avoid overcrowding in wards
 If any medical reasons keep the patient in clean
environment to protect them from colonization
Environmental cleaning of OT
 Floor should be cleaned at the end of each session and
scrubbed daily
 Spillages should be disinfected and removed as soon as
possible
 Lint free cloth is recommended for all operating theatres

46.  Infection control programs focus on identifying high
risk procedures and other possible sources of infection.
 High risk procedures should be performed only when
necessary
 Proper sterilization of instruments
 Frequent hand washing
 Strict antibiotic policy